Healthcare Provider Details

I. General information

NPI: 1013614189
Provider Name (Legal Business Name): MRS. MERCY AMO SEKYERE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 TAG CT
WOODBRIDGE VA
22193-4185
US

IV. Provider business mailing address

6155 TAG CT
WOODBRIDGE VA
22193-4185
US

V. Phone/Fax

Practice location:
  • Phone: 571-330-3091
  • Fax:
Mailing address:
  • Phone: 571-330-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024186401
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: